Everyday drugs: The rise and fall of HRT

Hormone replacement therapy surged in the 1980s and 90s – then its reputation for disease prevention and safety crashed. So what's the safest way to take it?

By Chloe Lambert

“The earlier a woman starts using HRT, the safer and more beneficial it is” (Image&colon; STEVE HORRELL/SPL)

Few treatments have been the subject of such confusing and conflicting findings as hormone replacement therapy, which surged in popularity in the West in the 1980s and 90s.

Back then, enthusiasts suggested that, as well as relieving menopausal symptoms such as hot flushes and night sweats, its benefits extended to protecting the heart and bones, and boosting libido.

That all changed when, in 2002, the Women’s Health Initiative, one of the biggest studies on the safety of HRT, showed that the treatment was not protective and might actually raise the risk of heart disease and breast cancer. The number of women using it dropped dramatically as a result (see graph). Around 6 million women take HRT in the UK and US at present.

In recent months, HRT has again made the news. A review, published in March, confirmed that HRT had no protective effect on the heart, and found it increased the risk of stroke in post-menopausal women.

It also slightly raises the risk of ovarian cancer, even if taken for just a few years, as is now the most common approach. For every 1000 women taking HRT for five years from around age 50, there would be one extra case of ovarian cancer.

“HRT is important and very effective against menopausal symptoms for many women,” says Phil Hannaford at the University of Aberdeen, UK. “However, the current advice is to use the smallest dose possible for the minimum period of time” – usually no more than …

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